Menstrual migraine. Methods of prevention and control

In many women, migraine headaches are clearly linked to estrogen levels: the incidence rises at the menarche; attacks may be precipitated by falling estrogen levels before menses; and symptoms usually improve during pregnancy when there are noncyclic high levels of estrogen. Decreased estrogen production in the perimenopausal phase may trigger an exacerbation of migraine. However, after menopause when estrogen levels are noncyclic and low, there may be an improvement in migraine. The falling estradiol level rather than the absolute level provides the trigger for menstruation-associated migraine. Treatment involves both prophylactic and acute measures. Therapy for an acute attack is similar to that for nonmenstrual migraine. Sumatriptan is equally effective for both nonmenstrual and menstrual migraine.